Provider Demographics
NPI:1083981443
Name:WEITKUNAT, SUSAN (MS RD CDE)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WEITKUNAT
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S WILCOX ST
Mailing Address - Street 2:#150
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1913
Mailing Address - Country:US
Mailing Address - Phone:303-807-4522
Mailing Address - Fax:
Practice Address - Street 1:140 S WILCOX ST
Practice Address - Street 2:SUITE A
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1911
Practice Address - Country:US
Practice Address - Phone:303-807-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
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